HomeMy WebLinkAboutP-14-491 P°°0pm C cot-�t OF " y°u) •
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pUNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
% CITY SOKT14 Jff� OGlr'�� ( MA DATE / -ZD- 1y PERMIT# Ply lig/k '
JOBSITE ADDRESS 1e 3 Q �yiip �Q OWNER'S NAME
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P OWNER ADDRESS CAtylr ITEL 85f53eOf2ta IFAX ,
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL[9-
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CLEARLY NEW:Er RENOVATION:E] :REPLACEMENT:❑ PLANS SUBMITTED: YES❑ ,NOQ
FIXTURES? FLOOR-, BSM 1 2 3 4 5 ' 6 7 - 8 '9 F.. 10 11 12 13 `14
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BATHTUB f t 1i i I { :.
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM - - ,( - —
DEDICATED GASIOILISAND SYSTEM . j ! ,
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM `+ f 'I-
DEDICATED WATER RECYCLE SYSTEM Ir i, ,r
DISHWASHER j '
DRINKING FOUNTAIN 1 j I 1 i -ii
FOOD DISPOSER 1 i . �I it �I! _ . (
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) r r --in -ir ir F _ r - ,
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
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WASHING
MACHINE CONNECTION
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JAN 44LU14 � r - _ -I ,i ir i
BUILDING DESNT INSURANCE COVERAGE:
I h wee current liabr surancan plicy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
,
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY❑ BOND ❑
OWNER'S INSURANCE WAIVER:lam aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement
_ _„ CHECK ONE ONLY: OWNER ❑ AGENT 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertine tpryvjsion of e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - /r {/�/
PLUMBER'S NAME WILLIAM H.POOLE LICENSE# 12879 w � SIGPjATTURE
MPC JP❑ CORPORATION0#2338C PARTNERSHIP❑# LLC❑#
COMPANY NAME HALL OIL CO.INC ,ADDRESS 435 RT 134
CITY SOUTH DENNIS STATE MA ZIP 02660 TEL 508-398-3831
FAX 508-394-3068 1 CELL 1 EMAIL bbq@cape.com L
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY-.`.: `: FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT =u ❑
FEE: $ PERMIT#a-
PLAN REVIEW NOTES - -